Healthcare Provider Details

I. General information

NPI: 1023932027
Provider Name (Legal Business Name): DIANE DELEONARDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N 1ST ST STE 225
SPRINGFIELD IL
62702-3760
US

IV. Provider business mailing address

901 N 1ST ST STE 225
SPRINGFIELD IL
62702-3760
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-4065
  • Fax: 217-788-4147
Mailing address:
  • Phone: 217-788-4065
  • Fax: 217-788-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029637
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: